Doctors avoid comprehensive preventative questioning

Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services.

According to the report, only 47% of patients with documented heart and vascular disease were given a recommendation to use aspirin for prevention. They additionally found that only 44% had their blood pressure under control. When looking at cholesterol and lipid control only 33% of the men and 26% of the women were tested with a blood lipid test in the last five years.  Of those patients who did measure their lipid levels, only 32% of the men and women surveyed had their lipids under control. Among diabetics, 13% had poor sugar control with a HgbA1C > 9 (goal is 6-8).

The data indicate that at 37% of the visits, patients weren’t asked about their smoking or tobacco status.  When patients were asked, and answered that they were smoking, only 21% were given smoking cessation counseling and only 7.6 % were prescribed medications or a way to stop smoking.

Screening for cancer needs improvement as well. Twenty percent of women between the ages of 50-74 had not had a mammogram in over two years.  In the same age group, a third of the patients were not current on screening for colon and rectal cancer.

The data was collected prior to the passage of the controversial Affordable Care Act. When the data was analyzed and divided according to socioeconomic status, education level, and health insurance status; it was clear that the poorest and least educated had the fewest screenings. It is hoped that with passage of the new health care law, and new insight by health insurers that it is cheaper to prevent a disease than treat it, these numbers will improve.

There are several other factors that need to be looked at as well. Data is now being collected from electronic medical health records.

I ask my patients about tobacco status on every patient visit.  When I note that the patient is smoking in their electronic health record, there are three or four ways to document counseling has been offered. Only one of them triggers the audit data for the government to review. Our software instructors were unaware of that when they taught us to use the system.  How much of this study is the result of data collection error is unknown.  “Health care providers” – not just physicians, are now delivering health care.

Access to physicians and a shortage of primary care physicians exacerbate the problem. It takes time to extract this information, record it, and counsel the patient. Because PCPs are underpaid, they will continue to see patients in high volumes to cover their expenses, causing the use of comprehensive preventative questioning to remain low.

Steven Reznick is an internal medicine physician and can be reached at Boca Raton Concierge Doctor.

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  • Hexanchus t

    While you make some good points, I feel I need to point out that especially with screening tests and exams, you require the patients informed consent. It is the job of the physician to explain not only the purpose of the test, but both the advantages and risks of having the test.

    As recent findings by USPSTF and studies by others have clearly brought into the light, there are very real risks of harm associated with some of these tests – not necessarily from he test itself, but from errors in the results that initiate unnecessary treatment and follow-up tests. IMHO, it is the ethical duty of the physician to provide the patient with ALL relevant information, both pro and con, and then allow the patient to make the decision. Unfortunately this is rarely done, at least in my personal experience.

    Once the patient makes a decision, the physician needs to accept that. It’s OK to disagree, and tell them why, but it is not ethical to brow-beat the patient into changing their decision, or to coerce them to do so by threatening to withhold other services, as is done all to often.

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